During endoscopic procedures, sutures are commonly introduced to the interior of the body of a patient with a knot pushing rod and removed therefrom with the aid of grasping forceps and scissors. The use of these known devices requires an access sheath or entry site in addition to the access sheath used by a surgeon for visualization or insufflation of the body cavity. To provide secondary access, a puncture is formed using a trocar needle, the puncture is dilated, and a sheath is positioned in the puncture through the abdominal wall. Providing additional access sites results in the increased duration of the procedure as well as the risk of complications to the patient.
An approach to removing a suture from the interior of the body of a patient is to use a combination subcutaneous suture probe. The probe includes an outer cutting tube, an inner hollow tube with a crochet-type hook positioned in the distal end thereof, and an inner clamping rod. The probe is positioned through the abdominal wall and into infected sinuses for probing and locating a loop of suture. The probe is pulled against the loop for positioning the suture thread in the crochet hook of the inner hollow tube. The inner clamping rod secures the suture therein. Then the outer cutting tube is advanced distally for cutting the suture thread on one side of the crochet hook. The suture thread remains grasped within the crochet hook of the device for removal from the body. A problem with the crochet hook and inner clamping rod of the probe is that the suture can be readily pulled from between the clamping surfaces thereof when attempting to pull on the suture and encountering any resistance therefrom. Another problem with the use of this probe is that the suture thread can be inadvertently cut on both sides of the crochet hook with the outer cutting tube. As a result, only a small piece of suture thread would remain within the device, leaving a length of suture extending from the abdominal tissue. Furthermore, with the suture thread already cut, no loop of suture remains for the probe to engage and pull into the crochet hook. Still another problem is that the inner hollow tube with the crochet-type hook can be bent during percutaneous insertion since the inner clamping rod does not extend through the hook and reinforce the hollow tube.
Another approach to introducing suture to the interior of the body of a patient and removing suture therefrom is the use of a suture threading, stitching, and wrapping device. The device includes a tissue clamping bracket and a shaft with a pointed front end and a hook directly behind the front end. In use, the U-shaped tissue clamping bracket positions a suture thread behind a mass of tissue. Then the pointed front end of the shaft penetrates the tissue mass for positioning the suture thread into the hook. The shaft is pulled proximally for drawing the suture thread through the tissue mass and into an outer tube. A problem with the use of this device is that it is introduced into the body of a patient via an access sheath or skin portal. Again, providing an additional access site results in the increased duration of the procedure as well as the risk of complications to the patient. Another problem with the use of this device is that the suture thread is positioned in the device by tensioning the suture thread. Suture thread can be inadvertently released from the device and, as a result, failed attempts to introduce suture into the body or remove suture therefrom can occur. Yet another problem with the use of this device is that suture thread can be inadvertently cut when drawing the shaft into the outer tube, if the tolerance between the shaft and tube is close enough to prevent release of the suture thread from the device. Conversely, the suture inadvertently slips out of the hook if the tolerance between the shaft and outer tube is far apart.